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New Accounts - Provider | Member

Piedmont WellStar Medicare

Piedmont WellStar Medicare Choice (HMO) - Routine Dental

Effective January 1, 2014, Avesis Third Party Administrators, Inc. will be administering dental benefits to Piedmont WellStar Medicare Choice HMO members in the counties of: Cherokee, Cobb, Coweta, Douglas, Fayette, Fulton, Henry, Paulding, Oickens, Rockdale, Spalding.

Below you will find a sample image of the ID card that members will present when they come to your office for services.

As a participating provider, it is imperative that you verify eligibility and benefits on all members each time they present in your office. Please remember that only the services covered by the member's benefit plan will be paid by Avesis.

Plan benefits include preventative services such as exams, cleanings and x-rays.

If you are an Avesis participating provider and are interested in participating in the program, please click here to obtain the provider addendum form.

If you are not currently an Avesis participating provider and are interested in participating in the program, please complete the provider agreement form by clicking here. Avesis participates with CAQH. If you have a CAQH number, please be sure that your credentials and attestation are current. Please make sure that you have selected “Global” for Avesis to receive your information. Once everything is current you may provide us with your CAQH number and exact name as it is on the CAQH. If you do not have a CAQH number, please contact us to assist you in obtaining one. All participating providers must have a NPI number. If you do not have a NPI number, please click here to apply. If you have any questions please contact one of our Provider Services Representatives at 800-843-0558.

Send Completed Materials by mail to Provider Services at:

Mail To:

Avesis Third Party Administrators, Inc.
10324 South Dolfield Road
Owings Mills, MD 21117